Obstructive lung diseases Flashcards
Type of lung disease indicated by decreased FEV1 and FEV1/FVC, and increased TLC and RV.
Obstructive lung diseases
Curvilinear flow-volume loop is seen in what type of lung disease
Obstructive
Lung disease characterized by mucous gland hyperplasia and hypersecretion within the bronchi.
Chronic bronchitis
Lung disease characterized by smooth muscle hyperplasia, excess mucous, and inflammation within the bronchi.
Asthma
Lung disease characterized by airspace enlargement and wall destruction in the acini.
Emphysema
Airway dilation and scarring in response to persistent or severe infections
Bronchiectasis
Most common type of emphysema
Centriacinar/centrilobular
Emphysema type commonly in the lower lung zones, involving the acinus.
Panacinar/panlobular
Type of emphysema seen in alpha-1 antitrypsin deficiency
Pancacinar/panlobular
Emphysema type associated with spontaneous pneumothorax in young adults. Seen adjacent to the pleura, and adjacent to areas of fibrosis, scarring, or atelactasis
Distal acinar
Emphysema characterized by subpleural blebs >1 cm
Bullous
Clinically insignificant emphysema type associated with scarring
Irregular
Gene mutation in alpha-1 antitrypsin deficiency
PiZZ (proteinase inhibitor) on chromosome 14
Change in pressure-volume curve in emphysema
Up and to the left
Entrance of air into the CT stroma of the lung, mediastinum, or subcutaneous tisse
Interstitial emphysema
Lung expands because air is trapped within it by tumor or foreign object, but there is no airway destruction
Obstructive overinflation
Pathogenesis of complications in emphysema
Damage to capillary bed
Hypoxic vasoconstriction
Secondary pulmonary HTN
Development of cor pulmonale
CHF
RHF secondary to a lung disease
Cor pulmonale
Clinical definition of chronic bronchitis
Productive cough for a least 3 months during 2 consecutive years without other cause
Inflammatory mediators in chronic bronchitis
Histamine
IL-13
Obstructive lung disease with an increased Reid index
Chronic bronchitis
Ratio of thickness of the gland layer to the thickness of the submucosa
Reid index
Hyperemia, swelling and edema of the mucous membranes of the lungs on gross inspection of cross section. Excessive mucinous or mucopurulent secretions. Heavy cases of secretions and pus fill the bronchi and bronchioles
Chronic bronchitis
Microscopy of the lung shows thickening of bronchiolar wall due to smooth muscle hypertrophy, goblet cell hyperplasia, and striking enlargement mucus-secreting glands of trachea and bronchi
Chronic bronchitis
Maximum thickness of the bronchial mucus glands internal to the cartilage divided by the bronchial wall thickness
Reid index
Normal Reid index value
0.4
DLCO in chronic bronchitis
Normal
DLCO in emphysema
Decreased
Pressure volume in chronic bronchitis in absence of emphysema
Nearly normal
Complications of chronic bronchitis
Pulmonary HTN
Cor pulmonale
Respiratory failure
Hypercapnia
Respiratory acidosis
GOLD stage of COPD with a decreased FEV1/FVC and normal FEV1.
Stage 1 - mild
GOLD stage of COPD with decreased FEV1/FVC and FEV1 between 50-80%.
Stage II - moderate
GOLD stage of COPD with decreased FEV1/FVC and FEV1 between 30-50%
Stage III - severe
GOLD stage of COPD with FEV1/FVC decreased and FEV1 <30%, or <50% with signs of respiratory failure or RHF.
Stage IV - very severe
Haldane effect
Administered O2 displaces CO2 bound to Hgb, increasing free CO2
Sign of irreversible bronchoconstriction in post-bronchodilator test
Change in FEV1 <=12%
General values of PO2 and PCO2 in respiratory failure
PO2 <60 mmHg
PCO2 >50 mmHg
4 general causes of hypoxemia
Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch
Pulmonary causes of V/Q mismatch
Obstructive lung diseases - chronic bronchitis
Restrictive lung disease
Pulmonary vascular disease
Acute respiratory distress syndrome (ARDS)
Chronic obstructive airway disease with variable expiratory outflow obstruction. Characteristic airway inflammation.
Bronchial asthma
Most common type of asthma
Atopic
Hypersensitivity reaction in atopic asthma
Type 1 hypersensitivity reaction
Inflammatory mediators seen in atopic asthma
Leukotrienes
Prostaglandin D2
Histamine
Serotonin
IL-4
IL-5
IL-13
Affect of inflammatory mediators in atopic asthma
Bronchoconstriction
Increased vascular permeability
Increased mucous secretion
Triggers of nonatopic asthma
Viral respiratory infections - most common
Inhalants
Cold
Exercise
Types of asthma
Atopic
Nonatopic
Drug induced
Occupational
Samter’s triad
Asthma
Aspirin sensitivity
Nasal polyposis
Agent often implicated in drug induced asthma
Aspirin
Microscopy of lung shows goblet cell hyperplasia, sub-basement membrane fibrosis, eosinophilic inflammation, and muscle hypertrophy
Asthma
Mucous plugs with whorls of shed epithelium
Curschman spirals
Collections of crystalloids made of eosinophil proteins (galectin-10)
Charcot-Leyden crystals
Curschman spirals and Charcot-Leyden crystals are seen in what obstructive lung disease
Asthma
DLCO in asthma
Often increased
Methacholine challenge test
> /=20% decrease in FEV1 in response to provoking factor
Destruction of smooth muscle and elastic tissue of lungs by persistent or severe infections causing permanent dilation of bronchi and bronchioles
Bronchiectasis
Congenital/hereditary conditions predisposing for bronchiectasis
Cystic fibrosis
Immunodeficiency states
Primary ciliary dyskinesia
Dilated bronchi on cut surface of lungs appears cystic and filled with mucopurulent secretions
Bronchiectasis
Microscopy of lung shows intense inflammatory cells, ulcerations of bronchial lining, squamous metaplasia, fibrosis, and destruction.
Bronchiectasis
Complications of bronchiectasis
Metastatic brain abscess
Secondary amyloidosis
Cor pulmonale
Pt presents with new onset of foul smelling, sometimes bloody sputum. Cough is worse in the morning. They had a cough and mild fever over the last week.
Bronchiectasis
Multi-system involvement of cystic fibrosis
Chronic lung disease
Pancreas insufficiency
Hepatic cirrhosis
Intestinal obstruction
Male infertility
Inheritance of cystic fibrosis
Autosomal recessive
Gene mutation of cystic fibrosis
CFTR on chromosome 7q31.2
Anion channels affected in cystic fibrosis
Chloride channels
Potassium channels
Epithelial sodium channels (ENaC)
Gap junction channels
Cellular processes affected in cystic fibrosis
ATP transport
Mucous secretion
Class I cystic fibrosis
Defective protein synthesis –> absent CFTR
Class II cystic fibrosis
Abnormal protein folding, processing, and/or trafficking –> absent CFTR
Phenylalanine at AA position 508
Class III cystic fibrosis
Defective channel regulation
Class IV cystic fibrosis
Defective CFTR channel
Class V cystic fibrosis
Reduced functional CFTR
Class VI cystic fibrosis
Decreased CFTR membrane stability
Meconium ileus
Thick viscid mucus plugs in the small intestines of infants in CF
Cause of male infertility in cystic fibrosis
Congenital bilateral absence of vas deferens
Diagnosis of CF via sweat chloride analysis
> 60 mmol/L
Diagnosis of CF via nasal transepithelial potential difference
More negative
Inheritance of primary ciliary dyskinasia
Autosomal recessive
Triad of Kartagener syndrome
Situs inversus
Bronchiectasis
Sinusitis
Cause of decreased fertility in both males and females in primary ciliary dyskinesia
Immotile sperm
Dysfunctional fallopian tube cilia
Risk factors for allergic bronchopulmonary aspergillosis
Asthma
Cystic fibrosis
Bronchiectasis
Indications for lung transplant
End stage COPD
Idiopathic pulmonary fibrosis
Cystic fibrosis
Idiopathic/familial pulmonary arterial HTN
Sarcoidosis
Most common reason for lung transplant
Cystic fibrosis
Prophylaxis for CMV pneumonia in the first few weeks post lung transplant
Ganciclovir
Prophylaxis for P jiroveci pneumonia in the first few weeks post lung transplant
Bactrim
Acute lung transplant rejection
Graft vessel vasculitis
Types of chronic lung transplant rejections
Bronchiolitis obliterans
Bronchiectasis
Pulmonary fibrosis
Fibrosis, scarring, and progressive obliteration of the small airways
Bronchiolitis obliterans
